目的:患者对甲状腺结节的偏好了解甚少。我们的目标是(1)采用离散选择实验(DCE)来探索甲状腺结节管理中的风险权衡,(2)将受访者分为偏好表型。
方法:DCE。
方法:甲状腺外科门诊,在线调查。
方法:DCE包括5个属性(癌症风险,声音担忧,切口/疤痕,用药要求,随访频率)通过定性患者和医生的输入进行细化。最终的DCE包括8个选择任务,人口统计,历史,对有甲状腺疾病和无甲状腺疾病的参与者进行风险耐受.使用多项logit建模和潜在类别分析(LCA)进行偏好表型分析。
结果:共纳入1026名受访者;480名患有甲状腺疾病。风险厌恶与年龄增长相关(P<.001),女性(P<.001),和有限的教育(P=.038),但不是以前的甲状腺疾病。癌症风险对决策的影响最大。在甲状腺结节决策的总可能效用变化中,47.8%归因于癌症风险的变化;20.0%来自药物管理;14.9%来自声音变化;12.7%来自切口/疤痕;和4.6%来自后续关注。LCA表现出3类具有不同的偏好表型:最大的组(64.2%)主要基于癌症风险做出决定;另一组(18.2%)基于对药物的厌恶而选择;最小的组(17.7%)平均考虑了药物和癌症风险。
结论:在治疗甲状腺结节时,癌症风险和甲状腺手术后需要服用药物对患者决策的影响最大。证明了不同的偏好表型,在治疗甲状腺疾病之前加强对个体偏好评估的需要。
OBJECTIVE: Patient preferences regarding thyroid nodules are poorly understood. Our objective is to (1) employ a discrete choice experiment (DCE) to explore risk tradeoffs in thyroid nodule management, and (2) segment respondents into preference phenotypes.
METHODS: DCE.
METHODS: Thyroid surgery clinic, online survey.
METHODS: A DCE including 5 attributes (cancer risk, voice concerns, incision/scar, medication requirement, follow-up frequency) was refined with qualitative patient and physician input. A final DCE including 8 choice tasks, demographics, history, and risk tolerance was administered to participants with and without thyroid disease. Analysis was performed with multinomial logit modeling and latent class analysis (LCA) for preference phenotyping.
RESULTS: A total of 1026 respondents were included; 480 had thyroid disease. Risk aversion was associated with increasing age (P < .001), female gender (P < .001), and limited education (P = .038), but not previous thyroid disease. Cancer risk most significantly impacted decision-making. Of the total possible utility change from thyroid nodule decision-making, 47.8% was attributable to variations in cancer risk; 20.0% from medication management; 14.9% from voice changes; 12.7% from incision/scar; and 4.6% from follow-up concerns. LCA demonstrated 3 classes with distinct preference phenotypes: the largest group (64.2%) made decisions primarily based on cancer risk; another group (18.2%) chose based on aversion to medication; the smallest group (17.7%) factored in medication and cancer risk evenly.
CONCLUSIONS: Cancer risk and the need to take medication after thyroid surgery factor into patient decision-making most heavily when treating thyroid nodules. Distinct preference phenotypes were demonstrated, reinforcing the need for individual preference assessment before the treatment of thyroid disorders.